A 45-year-old woman undergoes an ultrasound because of vague right upper quadrant pain and epigastric fullness. A 7 cm cystic lesion is detected. Which of the following statement(s) is/are true concerning the patient’s diagnosis and management?

c. The cyst is likely lined by cuboidal epithelium

d. Laparoscopic unroofing of the cyst can provide satisfactory treatment

A symptomatic solitary hepatic cyst may cause vague right upper quadrant discomfort or pain, a sensation of epigastric fullness or heaviness, and early satiety, however, most cases are asymptomatic. Complications are rare but include hemorrhage into the cyst, secondary bacterial infection, or obstructive jaundice from compression of extrahepatic ducts. In the absence of complications, laboratory abnormalities are uncommon. Cysts are somewhat more common in females, are more common in the right lobe and are often multilocular rather than unilocular. They are lined with cuboidal epithelium resembling bile duct epithelium and are filled with fluid that may be clear, mucoid, bloody, or bilious.

If the patient has no symptoms and the cyst was discovered incidentally and there is no evidence of infection or malignancy, one may observe the patient. Neither percutaneous aspiration nor surgery is indicated. Cysts nearly always recur after simple aspiration. Treatment of symptomatic cysts is surgical. Indications for surgery include symptoms, rupture, hemorrhage, or infection. Asymptomatic, uninfected simple cysts are best treated by excision, if possible. Larger cysts may be inroofed with free peritoneal drainage unless there is a history of hemorrhage or evidence of biliary communication. A laparoscopic approach to the unroofing of cysts has recently been reported with excellent success. If this cyst communicates with the biliary system (grossly by cholangiography) the leak may be oversewn or the cyst drained by a Roux-en-Y cystojejunostomy.